39 research outputs found
A randomized placebo-controlled trial of the anti-nerve growth factor antibody tanezumab in subjects with cancer pain due to bone metastasis
LADA and CARDS:a prospective study of clinical outcome in established adult-onset autoimmune diabetes
Effect of atorvastatin on C-reactive protein and benefits for cardiovascular disease in patients with type 2 diabetes: analyses from the Collaborative Atorvastatin Diabetes Trial
CARDS was partially funded by Diabetes UK and the
National Health Service Research and Development Forum (England)
Paleozoic adakitic rocks in the northern Altyn Tagh, northwest China: Evidence for progressive crustal thickening beneath the Dunhuang Block
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Endogenous tissue plasminogen activator and risk of recurrent cardiac events after an acute coronary syndrome in the MIRACL study
Objective
To examine the relationship of baseline tissue plasminogen activator (t-PA) to early cardiovascular risk after an acute coronary syndrome, and the effect of intensive statin therapy.
Methods
We measured plasma t-PA in 2860 of the 3086 (93%) subjects in the MIRACL study, an international randomized trial of atorvastatin 80â
mg daily versus placebo in patients with acute coronary syndromes. The relationship of t-PA to death, non-fatal acute myocardial infarction, cardiac arrest, or worsening angina over 16 weeks was assessed by Cox Proportional Hazards. D-dimer was measured in a random sample of 395 subjects.
Results
Higher baseline t-PA was significantly related to the risk of recurrent events (HRâ
=â
1.25, pâ
=â
0.0014). This relationship was unaffected by adjustment for age, sex, troponin, hsCRP, and lipids (HRâ
=â
1.17, pâ
=â
0.029), but was attenuated by adjustment including body mass index and smoking (HRâ
=â
1.14, p=0.08). D-dimer and t-PA concentrations were not related. Atorvastatin reduced the risk of recurrent events, but did not affect t-PA or D-dimer concentrations or the relationship of t-PA to outcomes.
Conclusion
In patients with acute coronary syndromes, increasing t-PA concentration was related to a higher early risk of recurrent events, paradoxically reflecting impaired endogenous fibrinolysis. This relationship is due in part to the association of t-PA with age, body mass index and smoking. Although statins lower the risk of recurrent events after acute coronary syndromes, it is unlikely that this benefit is achieved through thrombolytic and fibrinolytic pathways
MONOCYTE CHEMOATTRACTANT PROTEIN 1 PREDICTS FIRST CORONARY EVENTS BUT NOT RECURRENT STROKES: RESULTS FROM THE SPARCL STUDY
ELEVATED LEVELS OF OXIDIZED PHOSPHOLIPIDS ON APOLIPOPROTEIN B-100 PREDICT RECURRENT CEREBROVASCULAR EVENTS: A STROKE PREVENTION BY AGGRESSIVE REDUCTION IN CHOLESTEROL LEVELS (SPARCL) SUBSTUDY
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Inflammatory Biomarkers, Death, and Recurrent Nonfatal Coronary Events after an Acute Coronary Syndrome in the MIRACL Study
Background: In acute coronary syndromes, Câreactive protein (CRP) strongly relates to subsequent death, but surprisingly not to recurrent myocardial infarction. Other biomarkers may reflect different processes related to these outcomes. We assessed 8 inflammatory and vascular biomarkers and the risk of death and recurrent nonfatal cardiovascular events in the 16 weeks after an acute coronary syndrome. Methods and results: We measured blood concentrations of CRP, serum amyloid A (SAA), interleukinâ6 (ILâ6), soluble intercellular adhesion molecule (ICAM), soluble vascular cell adhesion molecule (VCAM), Eâselectin, Pâselectin, and tissue plasminogen activator antigen (tPA) 24 to 96 hours after presentation with acute coronary syndrome in 2925 subjects participating in a multicenter study. Biomarkers were related to the risk of death, and recurrent nonfatal acute coronary syndromes (myocardial infarction or unstable angina) over 16 weeks using Cox proportional hazard models. On univariate analyses, baseline CRP (P=0.006), SAA (P=0.012), and ILâ6 (P<0.001) were related to death, but not to recurrent nonfatal acute coronary syndromes. VCAM and tPA related to the risk of death (P<0.001, P=0.021, respectively) and to nonfatal acute coronary syndromes (P=0.021, P=0.049, respectively). Adjusting for significant covariates reduced the strength of the associations; however, CRP and SAA continued to relate to death. Conclusions: In acute coronary syndromes, the CRP inflammatory axis relates to the risk of death and may reflect myocardial injury. VCAM and tPA may have greater specificity for processes reflecting inflammation and thrombosis in the epicardial arteries, which determine recurrent coronary events